Provider Demographics
NPI:1326184110
Name:WHITES, PERRY M (DMD)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:M
Last Name:WHITES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 HIGHWAY 82 W STE A
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-5069
Mailing Address - Country:US
Mailing Address - Phone:662-453-5536
Mailing Address - Fax:662-453-2324
Practice Address - Street 1:702 HIGHWAY 82 W STE A
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-5069
Practice Address - Country:US
Practice Address - Phone:662-453-5536
Practice Address - Fax:662-453-2324
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2302-86122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060236Medicaid